Irritable Bowel Syndrome (IBS)
What is Irritable bowel syndrome?
The exact cause of IBS is not clear but it is thought to relate to the many nerves that control the gastrointestinal tract as well as possibly hormones which influence the functioning of these nerves.
There are no findings on any blood work, x-rays, or endoscopies that allow us to diagnose the condition. It is diagnosed by asking you questions and doing a complete physical examination, although you may undergo testing to exclude other things which can sometimes mimic symptoms of IBS.
IBS is extremely common, and is thought to affect about 20 to 25% of the North American population, 80% of which are women.
What are the symptoms of Irritable Bowel Syndrome?
Symptoms of IBS include bloating, gassiness as well as abdominal discomfort, sometimes made better by bowel movements or the passage of gas. In addition there are related alterations of bowel function with some patients having a diarrheal subtype others with a constipating subtype and yet other with an alternating diarrheal and constipating subtype.
It is important to understand that IBS is not an anatomical or structural problem, does not cause cancer and does not lead to other gastrointestinal diseases such as colitis or Crohns disease.
IBS is a very real disease and can have a substantial impact on patient's lives. It can sometimes also be related to other pain syndromes such as fibromyalgia as well as chronic fatigue.
How is Irritable Bowel Syndrome diagnosed?
If you are thought to have a diarrheal subtype of IBS, tests will be done to exclude other causes of diarrhea including stool cultures, ova and parasite examination, as well as Clostridium difficile testing. These are all done by taking a sample of the diarrhea to the lab for analysis. In addition your blood will be tested to rule out malabsorptive type diseases such as celiac disease which is a wheat intolerance. This can be diagnosed with a simple blood test called a TTG with 95% confidence. In addition a lactose intolerance test can be useful to ensure that you are not allergic to the sugar commonly found in milk. Finally your thyroid will be checked to ensure that it is not overactive causing the diarrhea. Based on your symptoms and age a colonoscopy may also be recommended.
If you have a constipating subtype your blood will be tested to ensure your calcium levels are not high and that your thyroid is not under active both of which can lead to constipation. In addition there are other tests that can be done by radiologists to examine the function of the colon including a Sitzmarker study were you swallow a pill containing small plastic rings that show up on an abdominal x-ray. You take the pill on a Sunday and have an abdominal x-ray on the following Wednesday and Friday and it is important that during this test you do not take any laxatives. In addition a radiologist can also do a defogram which is a study where they place barium paste into the rectum and take x-rays of the rectum as you have a bowel movement. This x-ray looks for any abnormalities in the pelvis that may relate to the constipation. Depending on your age and symptoms you may also be recommended to have a colonoscopy.
What are the Treatment options?
A diet low in fermentable sugars, called the low FODMAPs diet has been shown to help most people with IBS. These are a group of foods that contain sugars that aren't digested by the GI tract and become fermented by bacteria in the colon. This leads to bloating, pain, and changes in bowel habits. Adopting a low FODMAPs diet should only be undertaken with the support of your physician and/or a registered dietician as it can be difficult to maintain a nutritious diet. There are several great resources available from reputable sources:
The Stanford Low FODMAPS Nutritional guide
Fiber supplementation has also been shown to be possibly helpful for some people with IBS and you should try to get 25 g of fiber per day and this will require a substitute such as Kelloggs All Bran which you can mix with any cereal of your choice. Other alternative fiber supplements such as ground flax, Fiber One cereal, Metamucil, Benefiber, or any fiber supplement found in a health food store may also be helpful. It’s important to try different types of fiber if the first one you try does not agree with you. You can look at the nutritional information of all of the food that you eat and try to get 25 g of fiber per day. If you have constipation taking 8 cups of water per day along with the fiber is paramount and the water needs to be taken all day long in small quantities to keep the colon hydrated.
In addition to fiber probiotics, like Tu Zen or florastore have also been found to be helpful for some people and this may be in the form of activated bacterial cultured yogurt or any number of probiotic tablets that you can buy over-the-counter with bacteria such as acidophilus or other good bacteria to help with digestion.
There is also a medication called Iberogast which can be found at health food stores such as The Medicine Shop or Central Drugs and this has also been shown to be better than placebo for some patients with IBS. It is made up of 7 different natural herbs and costs about $30 per bottle.
Lifestyle modifications have also been found to be helpful for some people with IBS including a healthy exercise regimen as well as stress reduction techniques as often times people with IBS find that stress can make their symptoms worse.
Some patients with diarrhea may find some relief with medications such as Imodium which can be taken a half an hour before each meal as well as before bedtime and you can take up to two tablets 4 times per day for a total of 8 tablets. Unfortunately there are not any other medicines available in Canada, you may read about medications such as Zelnorm (tegaserod) which has recently been taken off of the market due to some cardiac toxicity concerns as well as alosetron which is not available in Canada due to concerns with significant side effects including decreasing the blood supply to the colon causing ischemic colitis.
Most people with Irritable Bowel Syndrome find that it can come and go throughout their lives but that by making appropriate changes to their diet and lifestyle, symptoms can be minimized.
There is a lot of information available on the internet and a good place to start is with the Canadian Society of Intestinal Research.